What is “Prehab’”?? And how to properly prepare for an elective surgery

By guest blogger Anthony Sinacore, PT, DPT, ATC

Barring any significant trauma requiring immediate medical attention, musculoskeletal surgeries are typically elective. Whether its a total joint replacement [of the knee, hip, and shoulders], a rotator cuff repair, or minor spinal surgeries, insurance companies won’t typically classify these as “necessary”, no matter how much pain you’re in.

Whatever the diagnosis is, when the time does eventually come where your pain or related-symptoms are too unbearable to manage, the appropriate step would be to seek out a trusted healthcare provider (i.e. your PCP, an orthopedist, or a physical therapist) to go over the options that may be best for you. Whomever you choose to see for this issue, It is important to have an open and clear conversation with this individual regarding what options you may have, if they align with your current goals, and what time-table for recovery these options provide. If you are unsatisfied with their recommendations, it is highly advisable to seek out a second opinion…remember this is your body we are talking about here.

However, every circumstance is different and there are many times when surgery is the best option. When this is the case, you are going to expect a successful outcome right?

This is where “Prehab” comes in.

Pre-surgical rehabilitation otherwise known as “prehab’’ has become a term referring to the preparatory interventions to help optimize a surgical outcome. In lay terms: setting yourself up for the best recovery possible.

This could mean improving range-of-motion through stretching, maximizing strength, or enhancing cardiovascular endurance to reduce muscle weakness and withstand disuse of the involved region during the initial stages of recovery.

While prehab may come off as common-sense to some, this stage is often neglected in the rehabilitation spectrum. And in most cases, avoiding prehab can be a costly mistake.

Too often have we heard of individuals who fought their pain for weeks, months, and years only to be frustrated to have just as long of a recovery process following surgery.

But why is this the case?

As pathology (take for example, end-stage arthritis of the knee) worsens, compensatory patterns within our daily movements creep in. We start getting up from chairs in a different way, we adjust how we turn around and walk, or we stop performing tasks altogether. I’m sure you know of someone who might say “I don’t do stairs unless I have to”. Let’s face it, pain hurts.

Unfortunately, these bad habits gradually lead to asymmetry. Those small compensatory patterns create a ripple effect across the musculoskeletal system. Muscles away from the injured area begin to work harder and becomes stronger further supporting the compensatory pattern. It isn’t before long that the affected area becomes weaker and stiffer leading to more pain when you do use it. This creates a vicious cycle and over the course of months or years, you decide its finally time to “get the surgery over with”

It’s difficult to remember that the surgery only offers a solution to fixing the source of the problem but not the symptoms associated from the initial issue, such as all the weakness and stiffness that came from “misusing” the area.

It is recommended to see a physical therapist roughly 1 month away from surgery to discuss what interventions may help you best prepare for the elected surgery. Ideally this should be the same therapist you will see after the surgery as they will already be familiar with you, your baseline measurements, and most importantly your rehab goals.

You also shouldn’t be worried about the expenses associated with prehab. A good physical therapist would be able to perform an evaluation and set you up with a comprehensive home exercise program in 1-2 visits. That way you can take the information and perform them independently at home. What better way to get you started on the road to recovery!

About Anthony Sinacore, PT, DPT, ATC

Anthony joined the Action Potential team in July 2018 and brings a wide variety of experience with him.  Prior to enrolling in physical therapy school, Anthony worked as an Athletic Trainer for a local high school in St. Louis, Missouri.  Understanding there can be a much deeper role in the rehabilitation setting, he then pursued his Doctorate degree in Physical Therapy from the University of Pittsburgh.  After graduation, Anthony worked as a ‘travel therapist’ in Texas, providing PT services in the home health and skilled nursing settings for a variety of patients with neurologic and musculoskeletal impairments.  These experiences allowed Anthony to develop a stronger passion for treating individuals, of all age-ranges, with complex musculoskeletal issues.  Anthony completed an Orthopedic Residency at the University of Delaware in 2018, allowing him to advance his Sports and Orthopedic skill sets.  He enjoys using whole-body movement to treat various conditions such as neck and back pain, knee pain, and shoulder complaints. He also believes there is nothing more important in healthcare than a collaborative, inter-disciplinary approach to treating an individual.  When he is not working, Anthony performs home-health visits on the weekend; otherwise you can find him at the local coffee shop reading up on the latest evidence/literature.

Anthony lives in Wilmington with his wife, Allie, and golden retriever, Yogi.  He enjoys traveling, reading (aka listening to audiobooks), playing pick-up basketball, and going on long runs.

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